Study: Lap surgery is safe during second trimester

Pregnant women can feel safer about under-going laparoscopic surgery in the second trimester, according to a recent study conducted at St. Luke’s Hospital in Bethlehem, PA. In the middle stages of pregnancy, the researchers found laparoscopic surgery is just as safe as open procedures, in addition to being less painful and requiring a shorter stay.

Laparoscopic surgery often is avoided by surgeons during the second and third trimesters. Because the stomach has to be filled with carbon dioxide gas, doctors often think the technique may be harmful to the fetus.

In retrospective chart reviews of 21 pregnant women who underwent laparoscopic surgery during their second trimester, "We found no detrimental outcomes whatsoever," reports Richard W. Conron Jr., DO, a surgical resident at St. Luke’s Hospital. Conron’s study was presented as a scientific exhibit at the 1997 Clinical Congress of the American College of Surgeons, based in Chicago.

No difference in fetal outcomes

On the contrary, between the two groups of women who had laparoscopic procedures and those who had open procedures, there was o difference in outcome for the fetus. More-over, the women who had laparoscopic procedures required significantly less postoperative pain medication and a decreased hospitaliza-tion period.

Partially based on the study results, Conron recommends laparoscopic procedures be performed between 13 and 26 weeks. The first trimester should be avoided because of possible abnormal fetal malformations common to this stage. The third trimester should be avoided because of a lack of manipulation space with the enlarged fetus.

"When a situation such as gallbladder problems [most commonly] or appendicitis comes up, everyone freezes because they don’t want to disturb the pregnancy," Conron explains. "The longer you let it go, the sicker the mother gets, and the more detrimental [the problem] is to the mother and fetus."

Currently, there’s not much information about laparoscopic techniques in medical literature. However, there have been at least four other studies, one of which, based on animal and human subjects, published unfavorable results in the American Journal of Surgery.1 The remaining three studies, published in Archives of Surgery,2 Journal of Laparoendoscopic Surgery,3 and Surgical Endoscopy,4 respectively, reported favorable results similar to Conron’s findings. According to the JLS report, "Laparoscopic surgery in pregnant patients is feasible and provides a reasonable alternative to the standard surgical approach."

"Overall, we plan to aggressively pursue laparoscopic surgery at this hospital," Conron adds. "The process will be ongoing with the handful of cases we get each year."

References

1. Amos JD, Schorr SJ, Norman PF, et al. Laparoscopic surgery during pregnancy. Am J Surg 1996; 171:435-437.

2. Curet MJ, Allen D, Josloff RK, et al. Laparoscopy during pregnancy. Arch Surg 1996; 131:546-551.

3. Posta CG. Laparoscopic surgery in pregnancy: Report on two cases. J Laparoendosc Surg 1995 Jun; 5:203-205.

4. Lemaire BM, van Erp WF. Laparoscopic surgery during pregnancy. Surg Endosc 1997; 11:15-18.